CARDINAL SYMPTOMS OF HEART DISEASE

SYMPTOMS
CHEST PAIN DYSPNEA SYNCOPE PALPITATION EDEMA COUGH HEMOPTYSIS EXCESS FATIGUE

DYSPNEA
Abnormally uncomfortable awareness of breathing Dyspnea after strenous activity- NORMAL INDIVIDUAL Dyspnea after moderate activity DECONDITIONED INDIVIDUAL Dyspnea becomes abnormal only if it occurs at rest or at a level of activity not expected to cause dyspnea

DIFFERENTIAL DIAGNOSIS OF DYSPNEA

PULMONARY - Reactive airways disease - COPD - pulmoary edema - pulmonary hypertension - infection - pulmonary embolism - pleural diseases - interstitial lung disease

DIFFERENTIAL DIAGNOSIS OF DYSPNEA

CARDIAC -ischemic heart dsease - right sided heart failure - arrhythmias - dilated cardiomyopathy - hypertrophic cardiomyopathy - valve stenosis and regurgitation

ACUTE DYSPNEA
Sudden development of dyspnea - pulmonary embolism - pneumonia - airway obstruction

CHRONIC DYSPNEA
Symptom progress slowly or gradual - HEART FAILURE - COPD ( chronic obstructive pulmonary disease )

DYSPNEA
INSPIRATORY DYSPNEA- obstruction in upper airway EXPIRATORY DYSPNEA- obstruction of lower respiratory tract EXCERTIONAL DYSPNEA- left ventricular failure or COPD FUNCTIONAL DYSPNEA- dyspnea at rest and not during activity

PAROXYSMAL NOCTURNAL DYSPNEA

Interstitial or interalveolar pulmonary edema Secondary to ventricular failure Symptom starts 2-4 hours after sleeping, patient arise from sleep feeling short of breath Symptom ameliorated by sitting on the side of bed and take about 15-30 min

ORTHOPNEA
Inability to breath comfortably when lying Severe pulmonary venous congestion is the cause of orthopnea Usually seen in advance heart failure were resting pulmonary venous pressure is elevated

CHEST PAIN
Cardinal manifestation of coronary heart disease There are other structures that can casue chest pain- Intrathoracic structures like aorta, pulmonary airway, pleura and mediastinum; tissue of the neck; thoracic wall and subdiaphragmatic structures

DIFFERENTIAL DIAGNOSIS OF CHEST PAIN

PULMONARY - pulmonary embolism - pneumothorax - pneumonia -

NEUROMUSCULAR - degenerative joint disease of cervical area - costochondritis - herpes zoster

PSYCHOGENIC - anxiety - depression - self gain

GASTROINTESTINAL - cholecystitis - esophageal spasm - GERD

NON CARDIAC CHEST PAIN

Pricking, lancinating, sharp, Location chest, but patient can pinpoint the location of the pain Occurs only a few seconds No relation to exercise, but usually aggravated by body movement or inspiration

CARDIAC CHEST PAIN

QUALITY OF PAIN LOCATION DURATION PRECIPITATING AND AGGRAVATING FACTORS

QUALITY OF PAIN
Angina means tightening Unpleasant sensation which is describe as either heaviness, pressing, squeezing or constricting

LOCATION
Anginal pain is substrenal in location Pain at times radiates to the jaw, left arm, or neck

DURATION
The pain of angina pectoris is usually brief irt would last between 2-10 minutes Chest pain lasting for more than 15 minutes would fall into either UNSTABLE ANGINA OR MYOCARDIAL INFARCTION

Precipitating factors
Angina pectoris is effort related It is usually releived by rest Other precipitating factors - cold - emotional stress Unstable angina pain is usually at rest Myocardial infarction rest pain with tissue destruction

SYNCOPE
Loss of consciousness commonly from reduced perfusion to the brain Causes of syncope - Cardiogenic Mechanical - outflow obstruction - pulmonary hypertension - myocardial disease low output

SYNCOPE
- Electrical bradyarrythmia tachyarrythmia - Neurocardiogenic vasovagal syncope orthostatic hypotension

SYNCOPE
- Other causes medication micturition cough acute pain states hypovolemia

SYNCOPE OF GRADUAL ONSET

VASODEPRESSOR SYNCOPE common faint HYPERVENTILATION

CARDIAC SYNCOPE
Rapid onset No convulsive movements No aura No post ictal confusional state

SYNCOPE
SYMPTOMS ONSET CONVULSIVE MOVEMENT AURA POST ICTAL STATE CARDIAC RAPID NONE NONE NONE SEIZURE GRADUAL PRESENT PRESENT PRESENT

COUGH
Cough due to left ventricular failure is dry, irritating , spasmodic and nocturnal it is due to pulmonary venous congention Cough of pulmonary disease is usually productive Cough follwed by dyspnea is usally pulmonary in nature while dyspnea follwed by cough is cardiac in nature

HEMOPTYSIS
Expectoration of blood in sputum RBC escapes into aleveoli Rupture of bronchial vessel Necrosis and hemorrahge into the alveoli

FATIGUE
Patient with impaired cardiovascular function - decrease peripheral perfusion - muscle weakness